These bones and ligaments comprise a “syndesmosis” – a joint in which bones are joined together by connective tissues such as ligaments and membranes, with only slight movement allowed.
As a result, high ankle sprains are sometimes referred to as syndesmotic injuries or syndesmotic ligament injuries.
This type of foot and ankle injury is far less common than the common ankle sprain (or low ankle sprain) which normally affects the ligaments on the outside of the ankle. It accounts for only 10% of ankle injuries, while the remaining 90% are lower or common ankle injuries.
As mentioned above, a high ankle sprain is one that causes damage to the ligaments above the ankle joint instead of to those on its outside (as happens with a normal inversion ankle sprain).
These ligaments are responsible for joining the two lower leg bones (the tibia and the fibula) in what is known as a syndesmosis. The soft tissues in the syndesmosis actually include two ligaments and a membrane:
High ankle sprains are usually the result of twisting, cutting or rotational forces being applied to the foot. In most cases, these forces cause inversion or external rotation of the foot (i.e. away from the body) with respect to the remainder of the leg. This type of force or impact usually happens while a person is running or jumping in contact sports like hockey, football or basketball.
The result of this twisting force is to cause damage first to the deltoid ligament on the inside of the ankle. However, the forces causing this damage are then transmitted up along the leg and through the syndesmosis ligaments listed above. The result of this damage to the syndesmosis ligaments will be pain just above the ankle at the point where the fibula and tibia meet.
Very high forces can continue up through the leg into the fibula itself, and can result in a fracture of the fibula well above the ankle This type of bone fracture is known as a Maisonneuve fracture..
The symptoms of a high ankle sprain normally depend on whether or not there is an associated fracture of the fibula:
Individuals experiencing these symptoms should seek medical advice at the earliest opportunity.
To diagnose a high ankle sprain, a doctor will likely conduct a physical examination of the injured lower leg and ankle.
A key goal will be determining whether the patient is experiencing pain at ankle level or above it. The patient may be asked to explain how the injury occurred.
The doctor will likely check for tenderness over the deltoid ligament on the inside of the ankle. That could be an indicator of the presence of a Maisonneuve injury as indicated above.
Palpation of the ankle (i.e. examination by touching) will probably be the preferred way to determine the location of the pain. Syndesmosis injuries will result in pain just above the ankle, whereas injuries to the lateral ligaments will cause pain at ankle level.
Two tests are normally critical in diagnosing a high ankle sprain:
To confirm whether the high ankle sprain is accompanied by an ankle fracture, doctors also need to conduct an imaging test such as an X ray scan. MRI or CT scans may also be used to assess the space between the tibia and the fibula and whether the syndesmotic ankle ligaments are managing to keep these two bones sufficiently close together.
In general, treating a high ankle sprain requires moving the tibia and fibula back into their correct positions relative to each other. They must then be kept in this position while healing proceeds.
Generally speaking, high ankle sprains require much longer to heal than do regular ankle sprains involving the lateral ligaments. Most studies suggest that the healing time is nearly twice as long.
For patients without a fractured fibula, treatment will be similar to that of a regular ankle sprain, and may include:
Physical therapy will be an important step in the treatment/recovery process. It will improve the strength of lateral ankle tendons (peroneal tendons) as well as help the patient recover ankle range of motion.
If the doctor detects the presence of a bone fracture, it is likely that surgery will be recommended to repair the injury. In general, the surgeon will restore the closeness of the tibia and fibula and hold them together with screws or suturing while healing proceeds.
Recovery times for high ankle sprains vary from six weeks up to six months before a return to sports can be contemplated.
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